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Aggressive, Early Treatment for Rheumatoid Arthritis Reduces Risk of Disability

ROCHESTER, Minn. — A generation ago, rheumatoid arthritis almost always led to disfigured joints and severe disability. Today, this disease still causes joint damage, discomfort and disability. But the risk of disability can be dramatically reduced when drugs that modify the immune system are started soon after the disease begins, according to the December issue of Mayo Clinic Health Letter.

Rheumatoid arthritis occurs when the immune system attacks joint linings (synovial membranes) that protect and lubricate the joints. The joint linings become inflamed and feel warm, painful and swollen. Muscle aches and fatigue may also occur. The onset can be sudden or subtle, involving swelling in only one or two joints.

When joint swelling occurs and lasts more than two weeks, it's important to see a physician. Persistent inflammation can lead to changes that damage cartilage, bone, tendons and ligaments. Medications can slow or stop this destructive process.

Aggressive drug treatment for rheumatoid arthritis starts as soon as possible. With several choices for medication, doctors increase dosages of drugs used — or add or take away drugs from the mix — until remission or very low disease activity is achieved. The intensity of early treatment improves the odds of remission. The longer the active disease persists, the less likely it will respond to drug therapy.

Exercise will very likely be part of the treatment plan, too. Older adults with rheumatoid arthritis — especially those newly diagnosed — are at risk of muscle weakness caused by the disease. A physical therapist can design an exercise program to strengthen muscles, increase exercise capacity and avoid joint irritations. Without safe exercise, a decline to disability can occur quickly, sometimes within weeks.

It's not entirely known what causes rheumatoid arthritis, but there's a strong genetic component that makes certain people more susceptible to triggering factors, such as a viral infection. While it can occur at any age, the peak age of onset is 56.